BEHAVIORAL PEDIATRICS
Congenital heart disease, parental stress, and infant-mother relationships Susan G o l d b e r g , PhD, Robert J. Simmons, MD, Jan N e w m a n , BA, Kathy C a m p b e l l , BA, a n d Rodney S. Fowler, MD From the Psychiatric Unit, the Departments of Psychology and Psychiatry, and the Cardiology Division, Hospital for Sick Children, Faculty of Medicine, Universityof Toronto, Toronto, Ontario, Canada The effect of congenital heart disease on early social relationships was assessed by observing 42 infants with the disease and 46 healthy infants in a standardized laboratory setting with their mothers. Significantly fewer infants with congenital heart disease, in comparison with healthy peers, were considered to have secure relationships with their mothers. The quality of the infantmother relationship in the group with congenital heart disease was not related to parents' reports of their own stress or psychologic well-being. Severity of illness did not have a direct effect on the quality of the infant-mother relationship, but securely attached infants showed more subsequent improvement in health than insecurely attached peers showed. Attention to the infant-mother relationship in clinical care may improve the social development of babies with congenital heart disease and may have positive effects on physical health as well. (J PEDIATR1991;119:661-6) It is generally assumed that care of an infant with congenital heart disease is difficult for parents and that parents may be particularly fearful about the future of such babies, but there is little empiric evidence of the early social development of these babies. There has been some interest, primarily in the nursing literature, in early care-giving problems among infants with CHD. An early study I of newborn infants with CHD particularly noted difficulty in feeding as a common problem. Before and 1 month after hospital discharge, Pinelli2 interviewed mothers of infants with CHD about their care-giving concerns. These concerns increased from the first to the second interview and focused around difficulties in identifying the needs of the infant. In a previous study, 3 mothers of 2- to 21-month-old infants with CHD reported difficulties in establishing comfortable social interactions with their infants. These studies are limited by Supported by grants from the Heart and Stroke Foundation of Ontario and Ontario Mental Health Foundation. Submitted for publication Jan. 24, 199l; accepted May 17, 1991. Reprint requests: Susan Goldberg, PhD, Psychiatric Research Unit, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1XS, Canada. 9/29/31046
the absence of a comparison group and, in two cases, 2, 3 by very small samples. Our study was designed to assess infant-mother relationships in an objective manner for a substantial number of infants with CHD and for a healthy comparison group. The assessment procedure that we used, the strange situation, has been used in numerous studies during the past 25 years; well-established norms for North American samples are available.4, 5 Furthermore, behavior in the strange situation has been shown to be an indicator that reflects previous home behavior 6, 7 and predicts features of subsequent social CHD TGA VSD
Congenital heart disease Transposition of the great arteries Ventricular septal defect
development.S-12 Because Canadian data are not included in published norms and local variation may occur, we chose to recruit a comparison sample of families with healthy infants, We expected that infants with CHD would have problematic relationships with their mothers in greater numbers than in the healthy group. We also expected the healthy group to provide data comparable to the published norms. In addition to asking whether infant-mother rela-
661
662
Goldberg et al.
The Journal of Pediatrics October 1991
T a b l e I. Demographic characteristics
Parents Years together Mother's age (yr) Mother's education (yr) Mother's occupation* Father's age (yr) Father's education (yr) Father's occupation Infants Age at follow-up (too) No. of boys No. of firstborn infants
CHD (n = 42)
Healthy (n = 46)
p
4.6 _+ 2.7* 27.1 ___4.6 13.1 __+2.8 7.I 4- 3.9
6.3 4- 3.4 30.3 ___5.4 13.8 + 1.8 6.6 _+ 3.9
Congenital heart disease, parental stress, and infant-mother relationships Susan G o l d b e r g , PhD, Robert J. Simmons, MD, Jan N e w m a n , BA, Kathy C a m p b e l l , BA, a n d Rodney S. Fowler, MD From the Psychiatric Unit, the Departments of Psychology and Psychiatry, and the Cardiology Division, Hospital for Sick Children, Faculty of Medicine, Universityof Toronto, Toronto, Ontario, Canada The effect of congenital heart disease on early social relationships was assessed by observing 42 infants with the disease and 46 healthy infants in a standardized laboratory setting with their mothers. Significantly fewer infants with congenital heart disease, in comparison with healthy peers, were considered to have secure relationships with their mothers. The quality of the infantmother relationship in the group with congenital heart disease was not related to parents' reports of their own stress or psychologic well-being. Severity of illness did not have a direct effect on the quality of the infant-mother relationship, but securely attached infants showed more subsequent improvement in health than insecurely attached peers showed. Attention to the infant-mother relationship in clinical care may improve the social development of babies with congenital heart disease and may have positive effects on physical health as well. (J PEDIATR1991;119:661-6) It is generally assumed that care of an infant with congenital heart disease is difficult for parents and that parents may be particularly fearful about the future of such babies, but there is little empiric evidence of the early social development of these babies. There has been some interest, primarily in the nursing literature, in early care-giving problems among infants with CHD. An early study I of newborn infants with CHD particularly noted difficulty in feeding as a common problem. Before and 1 month after hospital discharge, Pinelli2 interviewed mothers of infants with CHD about their care-giving concerns. These concerns increased from the first to the second interview and focused around difficulties in identifying the needs of the infant. In a previous study, 3 mothers of 2- to 21-month-old infants with CHD reported difficulties in establishing comfortable social interactions with their infants. These studies are limited by Supported by grants from the Heart and Stroke Foundation of Ontario and Ontario Mental Health Foundation. Submitted for publication Jan. 24, 199l; accepted May 17, 1991. Reprint requests: Susan Goldberg, PhD, Psychiatric Research Unit, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1XS, Canada. 9/29/31046
the absence of a comparison group and, in two cases, 2, 3 by very small samples. Our study was designed to assess infant-mother relationships in an objective manner for a substantial number of infants with CHD and for a healthy comparison group. The assessment procedure that we used, the strange situation, has been used in numerous studies during the past 25 years; well-established norms for North American samples are available.4, 5 Furthermore, behavior in the strange situation has been shown to be an indicator that reflects previous home behavior 6, 7 and predicts features of subsequent social CHD TGA VSD
Congenital heart disease Transposition of the great arteries Ventricular septal defect
development.S-12 Because Canadian data are not included in published norms and local variation may occur, we chose to recruit a comparison sample of families with healthy infants, We expected that infants with CHD would have problematic relationships with their mothers in greater numbers than in the healthy group. We also expected the healthy group to provide data comparable to the published norms. In addition to asking whether infant-mother rela-
661
662
Goldberg et al.
The Journal of Pediatrics October 1991
T a b l e I. Demographic characteristics
Parents Years together Mother's age (yr) Mother's education (yr) Mother's occupation* Father's age (yr) Father's education (yr) Father's occupation Infants Age at follow-up (too) No. of boys No. of firstborn infants
CHD (n = 42)
Healthy (n = 46)
p
4.6 _+ 2.7* 27.1 ___4.6 13.1 __+2.8 7.I 4- 3.9
6.3 4- 3.4 30.3 ___5.4 13.8 + 1.8 6.6 _+ 3.9
